Tan Si H S, Pei Yingzhi, Chan Chloe X, Pang Khang C, Lim Andrew K S, Hui James H, Ning Bo
Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Pediatric Orthopedics, Children's Hospital of Fudan University, Shanghai, China.
Bone Jt Open. 2024 Nov 7;5(11):999-1003. doi: 10.1302/2633-1462.511.BJO-2024-0045.R1.
Congenital pseudarthrosis of the tibia (CPT) has traditionally been a difficult condition to treat, with high complication rates, including nonunion, refractures, malalignment, and leg length discrepancy. Surgical approaches to treatment of CPT include intramedullary rodding, external fixation, combined intramedullary rodding and external fixation, vascularized fibular graft, and most recently cross-union. The current study aims to compare the outcomes and complication rates of cross-union versus other surgical approaches as an index surgery for the management of CPT. Our hypothesis was that a good index surgery for CPT achieves union and minimizes complications such as refractures and limb length discrepancy.
A multicentre study was conducted involving two institutions in Singapore and China. All patients with CPT who were surgically managed between January 2009 and December 2021 were included. The patients were divided based on their index surgery. Group 1 included patients who underwent excision of hamartoma, cross-union of the tibia and fibula, autogenic iliac bone grafting, and internal fixation for their index surgery. Group 2 included patients who underwent all other surgical procedures for their index surgery, including excision of hamartoma, intramedullary rodding, and/or external fixation, without cross-union of the tibia and fibula. Comparisons of the rates of union, refracture, limb length discrepancy, reoperations, and other complications were performed between the two groups.
A total of 36 patients were included in the study. Group 1 comprised 13 patients, while Group 2 comprised 23 patients. The mean age at index surgery was four years (1 to 13). The mean duration of follow-up was 4.85 years (1.75 to 14). All patients in Group 1 achieved bony union at a mean of three months (1.5 to 4), but ten of 23 patients in Group 2 had nonunion of the pseudarthrosis (p = 0.006). None of the patients in Group 1 had a refracture, while seven of 13 patients who achieved bony union in Group 2 suffered a refracture (p = 0.005). None of the patients in Group 1 had a limb length discrepancy of more than 2 cm, while ten of 23 patients in Group 2 have a limb length discrepancy of more than 2 cm (p = 0.006). In Group 1, four of 13 patients had a complication, while 16 of 23 patients in Group 2 had a complication (p = 0.004). Excluding removal of implants, four of 13 patients in Group 1 had to undergo additional surgery, while 18 of 23 patients in Group 2 had to undergo additional surgery following the index surgery (p = 0.011).
A good index surgery of excision of hamartoma, cross-union of the tibia and fibula, autogenic iliac bone grafting, and internal fixation for CPT achieves union and minimizes complications such as refractures, limb length discrepancy, and need for additional surgeries.
先天性胫骨假关节（CPT）传统上是一种难以治疗的疾病，并发症发生率高，包括骨不连、再骨折、畸形矫正和肢体长度差异。CPT的手术治疗方法包括髓内棒固定、外固定、髓内棒固定与外固定联合应用、带血管腓骨移植，以及最近的交叉融合术。本研究旨在比较交叉融合术与其他手术方法作为CPT治疗的一期手术的疗效和并发症发生率。我们的假设是，一种良好的CPT一期手术能够实现骨愈合，并将再骨折和肢体长度差异等并发症降至最低。
进行了一项多中心研究，涉及新加坡和中国的两个机构。纳入2009年1月至2021年12月期间接受手术治疗的所有CPT患者。根据一期手术将患者分组。第1组包括接受错构瘤切除、胫腓骨交叉融合术、自体髂骨移植和内固定作为一期手术的患者。第2组包括接受所有其他一期手术的患者，包括错构瘤切除、髓内棒固定和/或外固定，未进行胫腓骨交叉融合术。比较两组之间的骨愈合率、再骨折率、肢体长度差异、再次手术率和其他并发症。
本研究共纳入36例患者。第1组13例，第2组23例。一期手术时的平均年龄为4岁（1至13岁）。平均随访时间为4.85年（1.75至14年）。第1组所有患者平均在3个月（1.5至4个月）时实现了骨愈合，但第2组23例患者中有10例假关节未愈合（p = 0.006）。第1组患者均未发生再骨折，而第2组13例实现骨愈合的患者中有7例发生再骨折（p = 0.005）。第1组患者均未出现超过2 cm的肢体长度差异，而第2组23例患者中有十例肢体长度差异超过2 cm（p = 0.006）。第1组13例患者中有4例出现并发症，而第2组23例患者中有16例出现并发症（p = 0.004）。排除植入物取出，第1组13例患者中有4例需要进行额外手术，而第2组23例患者中有18例在一期手术后需要进行额外手术（p = 0.011）。
对于CPT，一种良好的一期手术，即错构瘤切除、胫腓骨交叉融合术、自体髂骨移植和内固定，能够实现骨愈合，并将再骨折、肢体长度差异和额外手术需求等并发症降至最低。
